Page 54 - 2022-36-中国全科医学

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Association of Therapeutic Effects on Psychological Status of Post-bariatric Patients One Year after Surgery
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ZHAO Kang ，XU Xinyi ，ZHU Hanfei ，LIANG Hui ，YANG Ningli ，LIN Rui ，XU Qin 1*
1.School of Nursing，Nanjing Medical University，Nanjing 211166，China
2.Department of Bariatric Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
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Corresponding author：XU Qin，Professor，Doctoral Supervisor；E-mail：qinxu@njmu.edu.cn
【Abstract】 Background Bariatric surgery is the effective treatment for obesity，however，the effect of surgery on
patients' psychological status is still unclear. Objective To investigate the treatment effects of bariatric surgery on patients'
psychological status one year after the surgery. Methods This is a retrospective cross-sectional study. This study selected
172 patients who underwent bariatric surgery in the department of general surgery，First Affiliated Hospital of Nanjing Medical
University during June 2019 to June 2020，and collected their clinical data. The indicators of the treatment effects of bariatric
surgery include body composition indicators〔Weight，Body mass index（BMI），Percentage of excess weight loss（EWL%），
Body muscle mass（BM），Body fat mass（BF），Visceral fat（VSF），metabolism-related biochemical indexes〔Alanine
aminotransferase（ALT），Aspartate aminotransferase（AST），Total protein（TP），Albumin（ALB）〕，preoperative
comorbidities，relief of comorbidities after surgery，postoperative complications，postoperative complaints，surgery methods；
Indicators of the postoperative psychological status include quality of life，perceived stress，general well-being and satisfaction
degree of surgery. This study used the12-item Short Form Survey（SF-12），Chinese version of the Perceived Stress Scale（CPSS），
General Well-being Schedule（GWS），Questionnaire of Bariatric Surgery Patient' Satisfaction Survey to investigate the
psychological status. This study used the Pearson correlation analysis and Spearman rank correlation analysis to explore the
correlation between body composition indicators and metabolic-related biochemical indexes and postoperative psychological
status，used the multivariate linear regression analysis to explore the factors that affect postoperative psychological status. Results
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One year after surgery，EWL% was（82.7±31.7）%，and BMI decreased by（10.3±4.3）kg/m . 96 patients（55.8%）had
metabolic-related comorbidities such as type 2 diabetes mellitus，hypertension，fatty liver before surgery，48 patients（27.9%）
achieved complete remission，30 patients（17.4%）achieved partial remission，and 18 patients（10.5%）had no remission
after surgery. Patients'weight，BMI，BM，BF，VSF，ALT，AST were lower than those before surgery，the TP and ALB were
higher than those before surgery（P<0.05）.The correlation analysis showed that patients' MCS scores were negatively correlated
with ΔALT（r s =-0.160，P=0.036）；the CPSS scores were negatively correlated with EWL%（r=-0.181，P=0.017）and
ΔBM%（r s =-0.174，P=0.022）but positively correlated with ΔALT（r s =-0.236，P=0.002）；the GWS scores were negatively
correlated with ΔALT（r s =-0.228，P=0.003）and ΔAST（r s =-0.216，P=0.004）；the satisfaction of surgery were negatively
correlated with ΔBMI（r=-0.171，P=0.025），ΔBF%（r=-0.174，P=0.022）and ΔVSF（r=-0.154，P=0.043）but
positively correlated with EWL%（r=0.284，P<0.001）. The multivariate linear regression analysis showed that postoperative
stomachache（β=-0.239，P=0.002）and postoperative fatigue（β=-0.169，P=0.025）were factors that affect PCS scores；
ΔALT（β=-0.181，P=0.017）and postoperative fatigue（β=0.171，P=0.024）were factors that affect MCS scores；EWL%
（β=-0.188，P=0.010），ΔBM%（β=-0.146，P=0.047），ΔALT（β=0.219，P=0.003）and postoperative fatigue
（β=0.169，P=0.022）were factors that affect CPSS scores；ΔALT（β=-0.254，P=0.001）and acid reflux（β=-0.251，
P=0.001）were factors that affect GWS scores；ΔBMI（β=-0.245，P=0.010），EWL%（β=0.247，P=0.003）and ΔBF%
（β=-0.366，P<0.001）were factors that affect satisfaction of surgery. Among the 96 patients with preoperative comorbidities，
multiple linear regression analysis showed that postoperative relief of comorbidities（β=0.411，P<0.001）and stomachache
（β=-0.192，P=0.040）were factors that affect PCS scores；ΔALT（β=-0.273，P=0.006）and acid reflux（β=-0.263，
P=0.008）were factors that affect MCS scores；postoperative relief of comorbidities（β=-0.220，P=0.024），ΔALT（β=0.301，
P=0.002），stomachache（β=0.214，P=0.023）and ΔVSF（β=0.212，P=0.031）were factors that affect CPSS scores；
postoperative relief of comorbidities（β=0.290，P=0.002），ΔALT（β=-0.310，P=0.001）and stomachache（β=-0.271，
P=0.004）were factors that affect GWS scores；postoperative relief of comorbidities（β=0.402，P<0.001），ΔBF%
（β=-0.452，P<0.001）and ΔBMI（β=-0.364，P<0.001）were factors that affect satisfaction of surgery. Conclusion
Patients' BMI decreased significantly one year after bariatric surgery. The postoperative acid reflux，stomachache，fatigue and the
increase of ΔBF% and ΔALT negatively affect patients'psychological status；the increase of EWL% and ΔBM% positively affect
patients'psychological status. For patients with comorbidities，the higher the degree of postoperative comorbidity remission，the
greater the positive impact on the patient's psychological status.
【Key words】 Obesity；Bariatric surgery；Treatment effects；Psychological status；Root cause analysis